Securing the Unsecurable: A Guide to Managing Legacy Medical Device Risks
In any hospital or healthcare facility, the most significant cybersecurity threat might not be a sophisticated new attack, but a trusted piece of equipment that has been in service for years. Legacy medical devices—from MRI machines and infusion pumps to patient monitors—are often the workhorses of patient care. However, many were designed and built before modern cybersecurity was a consideration, leaving them unpatchable and dangerously exposed to today’s digital threats.
Managing these devices isn’t just an IT problem; it’s a critical issue of patient safety and operational stability. A single compromised device can lead to data breaches, disrupt clinical workflows, or even cause direct harm to a patient. The challenge lies in protecting systems that cannot protect themselves.
This guide outlines a strategic approach to managing the risks associated with unpatchable legacy medical devices, ensuring patient care remains secure and uninterrupted.
Why Unpatchable Devices Pose a Critical Threat
Legacy medical devices present a unique and formidable challenge for several reasons. Understanding these vulnerabilities is the first step toward mitigating them.
- Outdated Operating Systems: Many critical devices run on unsupported operating systems like Windows XP or Windows 7. These platforms no longer receive security updates from the manufacturer, meaning any newly discovered vulnerability will never be patched, leaving a permanent open door for attackers.
- Lack of Vendor Support: The original manufacturer may no longer be in business, or the device may be past its official end-of-life date. Without vendor support, there is no one to provide security patches or guidance when a new threat emerges.
- No Built-in Security: These devices were often built for a single purpose in a trusted, isolated network environment. They typically lack basic security features like encryption, strong password requirements, or authentication protocols, making them easy targets on a modern, interconnected network.
- Critical to Operations: Unlike a standard office computer, you cannot simply turn off a vital piece of medical equipment for a security scan or take it offline for remediation. Their constant need for uptime makes traditional security measures difficult to implement without jeopardizing patient care.
When these vulnerabilities are exploited, the consequences can be devastating, ranging from crippling ransomware attacks that shut down hospital operations to breaches of sensitive patient data and, in the worst-case scenario, catastrophic patient safety incidents.
A Four-Step Framework for Legacy Device Security
Since you can’t patch the vulnerability within the device itself, the strategy must shift to building a protective shield around it. This involves a multi-layered approach that reduces the device’s attack surface and monitors for suspicious activity.
1. Create a Comprehensive Inventory and Risk Assessment
You cannot protect what you don’t know you have. The foundational step is to build a complete and detailed inventory of every connected medical device in your organization.
- Identify and Catalog: Document each device’s make, model, operating system, software version, and location.
- Map Network Connections: Understand how each device connects to the network, what it communicates with, and whether it has access to the internet.
- Assess Criticality: Prioritize devices based on their role in patient care. A ventilator or infusion pump carries a much higher risk profile than a diagnostic device in a lab. This risk assessment will guide your security investments and help you triage remediation efforts.
2. Implement Robust Network Segmentation
If a device cannot be secured, it must be isolated. Network segmentation is one of the most effective strategies for protecting unpatchable systems. The goal is to create small, isolated network zones, or “VLANs,” that contain vulnerable devices and strictly control all traffic flowing in and out.
- Isolate Legacy Devices: Place all unpatchable legacy systems on a separate, dedicated network segment, away from the main hospital network and critical systems like electronic health records (EHR).
- Enforce “Least Privilege” Access: Use firewalls and access control lists (ACLs) to ensure the device can only communicate with the specific systems and services it absolutely needs to function. All other traffic should be blocked by default. For example, an imaging machine should only be allowed to send data to the PACS server, not browse the internet or access the billing system.
3. Deploy Compensating Controls and Enhanced Monitoring
Compensating controls are security measures put in place to make up for the inherent weaknesses of the device. Since you can’t install security software on the device itself, you must monitor the network traffic around it.
- Intrusion Detection and Prevention Systems (IDS/IPS): Place these systems on segmented networks to actively monitor for malicious traffic patterns or known attack signatures. An IDS can alert your security team to an attempted breach, while an IPS can automatically block it.
- Continuous Monitoring: Establish a baseline of normal network behavior for each device. This allows your security tools and team to quickly identify anomalies that could indicate a compromise, such as a device trying to communicate with an unknown external server.
4. Establish a Strategic Lifecycle Management and Replacement Plan
While isolation and monitoring are effective short-term strategies, they are not a permanent solution. The ultimate goal is to phase out dangerously outdated equipment.
- Develop a Replacement Roadmap: Using the risk assessment from your inventory, create a multi-year plan for retiring and replacing the highest-risk legacy devices.
- Factor Security into Procurement: Make cybersecurity a mandatory requirement in the purchasing process for all new medical devices. Ensure that new contracts include clear language about long-term security support, patching timelines, and vendor responsibilities. This proactive approach prevents you from purchasing the next generation of legacy problems.
By treating the security of medical devices with the same seriousness as clinical efficacy, healthcare organizations can protect their infrastructure, their data, and most importantly, their patients from harm.
Source: https://www.helpnetsecurity.com/2025/10/28/patty-ryan-quidelortho-legacy-medical-devices-cybersecurity/
